Federal Legislation for Pricing Transparency?

The House has 3 bills under consideration for promoting health care pricing transparency. Unfortunately, there is no commitment for moving the legislation through this year. And no bills introduced in the Senate yet.

The worst indication of where this may be heading came from Frank Pallone, chairman of the Energy and Commerce health subcommittee. “The concern I guess is about the unintended consequences of too much transparency,” he said. Apparently he believes such transparency will make prices go higher since Peter Orszag stated so back in 2008. If we assume that future health benefits will preserve the worst parts of the insurance models, then maybe that is possible.

However, if we look at private reform and adopt the newer benefit designs with consumerism, then we are much more likely to see prices fall as consumers engage in their care decisions.

Until the legislature brings meaningful pricing disclosure requirements, consumers can find fair price estimates for free at Healthcare Blue Book.

The three bill were summarized by California HealthLine

Bill Details

HR 4700: The bill -- sponsored by Rep. Steve Kagan (D-Wis.) without any Republican support -- would require hospitals, physicians, nurses, pharmacies, and a number of manufacturers and vendors to disclose publicly the prices they would charge patients. The HHS secretary would levy a fine on providers and vendors that fail to comply with the requirement (Ethridge, CQ Today, 5/6).

HR 2249: Cosponsored by Texas Reps. Gene Green (D) and Michael Burgess (R), the bill calls for transparency in hospital charges (Pecquet, "Blog Briefing Room," The Hill, 5/6). The legislation also would expand reporting requirements to all 50 states and require insurance companies to disclose out-of-pocket cost estimates for a number of medical procedures (Reichard, CQ HealthBeat, 5/6).

HR 4803: The proposal, sponsored by House Energy and Commerce Committee ranking member Rep. Joe Barton (R-Texas) with broad Democratic support, would cover ambulatory surgical centers serving patients who are not hospitalized after their operation ("Blog Briefing Room," The Hill, 5/6). It would require the centers, as well as hospitals and private and public health insurers, to disclose to their patients and customers information about the costs for services they provide and the items and services that they cover, respectively (CQ Today, 5/6).

See also comments at:
The Hill

Wisconsin Legislation for Price Transparency

In the fall of 2009 there were a lot of articles on 'facility fees' that are added to doctor's bills for office visits when the doctor works for a hospital.

Wisconsin is now considering requiring pricing transparency for the extra fees. Proposed legislation (AB 207) would require clinics that charge "facility fees" - meant to cover extra costs incurred by hospital-owned facilities - to tell people about them at the time they make appointments and to provide an estimate of what they will be.

Wisconsin has already passed one law to encourage pricing transparency, thought the law does not take effect until 2011. Wisconsin Act 146 requires hospitals and other health care providers to give patients a list of common procedures and what the provider charges for them, as well as what Medicare and insurers typically pay for them. This will provide some very useful information for patients.

In addition, Wisconsin is considering a law that would would require health care providers to give patients an estimate of the cost of any procedure, test or other service if it is expected to be more than $500. It would also require more disclosure to patients by insurance companies of the coverage amounts for certain medical services and estimates of out-of-pocket costs and costs for services from out-of-network providers. (Assembly Bill 539)